Description of the Mental Health and Psychosocial Support (MHPSS) Program Run by Médecins Sans Frontières – Spain (MSF) in Borno State, Nigeria

Abstract

Introduction: Mental Health and psychosocial support (MHPSS) programs are essential during humanitarian crises. For the last 20 years and over 200 projects worldwide, Medecins Sans Frontieres (MSF) integrates MHPSS when responding to humanitarian crises. Here we describe an MSF-Spain MHPSS program, including patients’ clinical features, sociodemographic characteristics, and intervention outcomes. Methods: Retrospective study of 11,709 patients who attended MHPSS program in Pulka and Gwoza (Nigeria) during 2018 and 2019. Patients' information, symptoms, stressors, severity (CGI-S scale), and clinical improvement (CGI-I and MHGS scales) were assessed by patient and counselor during the intervention. Patients' characteristics and associations between symptoms, stressors, severity of illness and clinical improvement are presented.. Findings: Among patients, 78% were classified as of mild or moderate severity at enrollment. Anxiety and depression were the most common disorders. Sexual violence, torture, and other conflict/violence related stressors were strongly associated with posttraumatic stress disorder (PTSD). Being an unaccompanied minor was associated with higher severity. Most patients presented an improvement in outcome at discharge, either by counselor rating (92%, CGI-I) or self-rated (73%, MHGS). Patients who benefited from three to six sessions, according to severity, were more likely to present improvement. Interpretation: The number of sessions together with the most powerful potentially traumatic stressors identified were decisive factors associated with patient’s improvement. Therefore, the identification of patients’ stressors and severity to provide the most appropriate number of sessions, and the reduction of the drop-out rate, should be prioritized. Funding Information: Medicins sans Frontieres is the only funding source for this research by the corresponding salaries paid to their employees. Declaration of Interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest other than Medecins Sans Frontieres, or non-financial interest in the subject discussed in this manuscript. Ethics Approval Statement: As this study utilized routine programmatic data and took the necessary steps to protect patient confidentiality, it was exempted from full review by the MSF Ethical Review Board and the National Health Research Ethics Committee of Nigeria (NHREC).